Provider First Line Business Practice Location Address:
509 N STATE OF FRANKLIN RD STE 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-8215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-328-5119
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2026